Atriuretic peptide in predicting perioperative cardiac events in patients undergoing major

Atriuretic peptide in predicting perioperative cardiac events in patients undergoing major non-cardiac surgery. Br J Anaesth 2007, 99:170-176.Figure 1 (abstract P234)Plot of the mean ScvO2 values versus their difference by the Bland ltman method.SAvailable online Venous oxygen saturation and lactate gradient from the superior vena cava to the pulmonary artery in ICU patients with septic shockP Kopterides1, I Mavrou1, E Kostadima2, E Zakynthinos2, M Lignos1, G Kontopithari1, E Papadomichelakis1, M Theodorakopoulou1, I Tsangaris1, G Dimopoulos1, I Dimopoulou1, S Orfanos1, S Bonovas3, A Armaganidis1 1`Attiko’ University Hospital, Athens, Greece; 2University Hospital of Larissa, Greece; 3Center for Diseases Control and Prevention, Athens, Greece Critical Care 2009, 13(Suppl 1):P235 (doi: 10.1186/cc7399) Introduction Central venous oxygen saturation (ScvO2) is considered comparable with mixed venous oxygen saturation (SvO2) in the Isosulfan blue initial resuscitation phase of septic shock [1]. Our aim was to assess their agreement in septic shock in the ICU setting and the effect of a potential difference in a computed parameter, namely oxygen consumption. In addition, we sought for a central venous to pulmonary artery (PA) lactate gradient. Methods We enrolled 37 patients with septic shock who were receiving noradrenaline infusions and whose attending physicians had placed a PA catheter for fluid management. Blood samples were drawn in succession from the superior vena cava (CV), right atrium (RA), right ventricle and PA. Hemodynamic and treatment parameters were monitored and data were compared by correlation and Bland ltman analysis. Results SvO2 was lower than ScvO2 (70.2 ?11.4 vs. 78.6 ?10.2 ; P <0.001), with a bias of ?.45 and 95 limits of agreement ranging from ?0.23 to 3.33 . This difference correlated significantly to the noradrenaline PubMed ID: infusion rate and the oxygen consumption and extraction ratio. These lower SvO2 values resulted in a computed oxygen consumption calculated with oxygen saturation of pulmonary artery blood higher than the oxygen consumption calculated with oxygen saturation of central venous blood (P <0.001), with a bias of 104.97 ml/min and 95 limits of agreement from ?.12 to 214.07 ml/min. Finally, lactate concentration was higher in the CV and RA than in the PA (2.42 ?3.15 and 2.35 ?3.16 vs. 2.17 ?3.19 mmol/l, P <0.01 for both comparisons). Conclusions Our data suggest that ScvO2 and SvO2 are not equivalent in ICU patients with septic shock. Additionally, the substitution of ScvO2 for SvO2 in the calculation of oxygen consumption produces unacceptably large errors. Finally, the decrease in lactate between RA and PA may support the hypothesis that the mixing of RA and coronary sinus blood is at least partially responsible for the difference between ScvO2 and SvO2. Reference 1. Marx G, Reinhart K: Venous oximetry. Curr Opin Crit Care 2006, 12:263-268.perfusion. StO2 measurements may be more correctly interpreted if measured in association with the forearm-to-fingertip skin-temperature gradient (Tskin-diff). A Tskin-diff threshold of 0 has been showed to reflect vasoconstriction. We aimed to propose a different approach for the interpretation of StO2 by adding Tskindiff monitoring and to characterize the pattern of StO2 dynamics in patients with peripheral vasoconstriction and vasodilation. We hypothesize that monitoring StO2 with Tskin-diff can more adequately predict ICU complications t.